Treatment of Skin Abscesses

Classification and Treatment

The World Journal of Emergency Surgery recommends classifying skin abscesses as simple or complex based on their characteristics 3
Simple abscesses have induration and erythema limited to a defined area and do not extend beyond its borders 2
Complex abscesses may involve perianal, perirectal areas, or intravenous drug injection sites and may require more aggressive management 2
Primary treatment for simple abscesses is incision and drainage alone 1, 2
The World Journal of Emergency Surgery suggests that cutaneous abscesses are typically caused by bacteria representing the normal regional skin flora 2

Complex abscesses require incision and drainage with adjuvant antibiotic therapy 2
Antibiotic therapy is recommended for complex abscesses if systemic signs of infection are present, the patient is immunocompromised, source control is incomplete, or significant cellulitis surrounds the abscess 1, 2
Empiric broad-spectrum antibiotic therapy with coverage of Gram-positive, Gram-negative, and anaerobic bacteria is recommended for complex abscesses 2
If MRSA is suspected, consider glycopeptides or newer antimicrobials 1

A large abscess should be drained with multiple counter incisions rather than a long incision to prevent step-off deformity and delayed wound healing 2
For perianal and perirectal abscesses, prompt surgical drainage is essential to prevent expansion into adjacent spaces and progression to systemic infection 2

Misdiagnosis by failing to differentiate between simple and complex abscesses can be avoided by proper classification 3
Prescribing antibiotics for simple abscesses when not indicated should be avoided 1, 2
Failure to identify a fistula tract in perianal abscesses may lead to recurrence 2